Autonomic Nervous System Agents (ch 18-19) Flashcards
1
Q
Autonomic Nervous System
A
“Automatic” or Involuntary
Include Afferent and Efferent neurons
Efferent pathways are divided into Sympathetic and Parasympathetic NS
2
Q
Peripheral Nervous System
A
Located outside the CNS
Divided into Automatic and Somatic NS
3
Q
Sympathetic NS neurotransmitter
A
Norepinephrine
4
Q
Parasympathetic NS neurotransmitter
A
Acetylcholine
5
Q
Sympathetic Nervous System
A
“Fight or Flight”
Activated by conditions of stress
Increases HR, BP, CO; dilate brochi, dilates pupils (mydriasis)
6
Q
Parasympathetic Nervous System
A
“Rest and Digest”
Promotes digestive processes
Decrease HR, BP; constrict bronchi, contricts pupils (miosis)
7
Q
Function of Alpha and Beta Adrenergics
A
“Fight or Flight”
dilates pupils and bronchioles
increses HR
contricts peripheral blood vessels
relaxes bladder.
8
Q
Alpha1 and Alpha2
A
Alpha1: bloodvessels (constrict)
Alpha2: bloodvessels (dilate), smooth muscle
9
Q
Beta1 and Beta2
A
Beta1: heart
Beta2: lungs
10
Q
Inactivation of Neurotransmitters
A
- Reuptake of the transmitter back into the neuron
- Enzymatic transformation or degradation
- Diffusion away from the transmitter
11
Q
Direct-acting Sympathomimetics
A
Epinephrine
Directly stimulates
12
Q
Indirect-acting Sympathomimetics
A
Amphetamine
Stimulate through and indirect way
13
Q
Mixed-acting Sympathomimetics
A
Ephedrine
14
Q
Epinephrine
A
Nonselective (Acts on more than one receptor): Alpha1, Beta1, Beta2
15
Q
Epinephrine: Pharmacodynamics
A
- Treats anaphylaxis
- Increases CO, HR, and systolic BP
- Promotes vasoconstriction
- Bronchodilation
- Renal vasoconstriction (decresing UO)
- Onset of action and peak concentration are rapid
16
Q
Epinephrine: Pharmacokinetics
A
- ROA: Subcut, IV, topically, inhalation, intracardiac, instillation
- Is rapidly metabolized by the GI tract and liver so it should not be given PO
- Half-life and protein binding is unknown
17
Q
Epinephrine: Contraindications and Cautions
A
- Cardiac disrythmias
- Glaucoma (aqueous humor), BPH
- Hypertension
- Hyperthyroidism
- Pregnancy
18
Q
Norepinephrine
A
- Alpha1, Beta1
- Used for shock, potent vasoconstrictor
- Given IV as infusion, titrated (seen in ICU)
19
Q
Dopamine
A
- Alpha1, Beta1, Dopaminergic
- Used to treat hypotension/shock
- Increases renal perfusion (low dose)
- Increases BP (higher dose)
- IV infusion
20
Q
Albuterol
A
- Selective: Beta2
- Used to treat bronchospasm, asthma, bronchitis, COPD
- Oral, inhaler, nebulizer
21
Q
Doputamine
A
- Selective: Beta1
- Used to treat cardiac decompensation by enhancing myocardial contractility, SV, CO; used to treat CHF
- IV with dose titrated to achieve effect
22
Q
Terbutaline Sulfate
A
- Selective: Beta2
- Used to treat bronchospasm or premature labor
- PO, SC, or IV
23
Q
Pseudoephedrine
A
- Alpha1, Beta1
24
Q
Alpha1 Receptor Blocker Effects
A
- Vasodilation, decrease in BP, miosis, reduction in contraction of smooth muscles in bladder neck and prostate gland
- Used for hypertension and BPH
- Side Effects: Cardiac disrythmias, flushing, hypotension, reflex tachycardia
25
List the Alpha1 Receptor Blockers
**-osin**
## Footnote
**Prazosin**: (Minipress) hypertension, angina, CHF, BPH, vasospasms associated with Raynaud's
**Doxazosin**: (Cardura) hypertension, BPH
**Tamsulosin**: (Flomax) BPH
**Terazosin**: (Hytrin) BPH
\***Phentolomine**: (Regitine) used to block the effects of infiltrated alpha agonists like dopamine or dobutamine
26
Nonselective Beta-Adrenergic Blockers
**-olols**
Used to treat hypertension, angina, dysrythmias
**Propranolol**: (Inderal)
Contraindications: Allergy, bradycardia, heart block, shock, CHF, bronchspasm, COPD, asthma, pregnancy, lactation, diabetic/hypoglycemic, thyrotoxicosis, hepatic dysfunction...
Side Effects/Adverse Reactions: bradycardia, laryngospasm, dysrythmias, hypotension, headaches, hyperglycemia/ hypoglycemia, agranulocytosis, impotence, decreased labido...
Drug Interactions: almost everything!
27
-olol
Beta-Adrenergic Blockers
28
-osin
Alpha1 receptor blockers
29
Alpha-beta Adrenergic Blockers
**Carvedilol (**Coreg**)**
**Labetalol**
30
Selective Beta Blockers
Used to treat hypertension and glaucoma
**Metoprolol tartrate** (Lopressor)\*
**Atenolol** (Tenormin)
**Betaxolol** (Kerlone, Betoptic)
**Nebivolol** (Bystolic)
Contraindications, side effects, & adverse effects same as propranolol
\*one of the top 15 drugs in 2009
31
First Dose Hypotension
Given at night because of relaxed vascular system, they stand up and the blood falls to their feet.
32
Are you able to suddenly discontinue any beta blocker?
No! Dose should be tapered off.
33
Client Teaching for Beta-Blocker patients
* Get out of bed slowly
* Monitor Pulse (60-100)
* Do not discontinue abruptly (up to 2 wks)
* Take at the same time each day even if they feel "OK"
34
Cholinergics/Parasympathomimetics
Neurotransmitter
Acetylcholine (Ach)
35
Cholinergics/Parasympathomimetics
Receptors
Muscarinic receptors
Nicotine Receptors
36
Cholinergics/Parasympathomimetics
Effects on body organs
Cholinergic nerve is Vagus Nerve
Increases Peristalisis
Contracts Bladder
37
Direct-Acting Cholinergic Drugs
**Metoclopramide HCl** (Reglan): PO/IM/IV; GI stimulant, antiemetic
**Pilocarpine HCl** (Pilocar): opthalmic drops; reduce intraocular pressure
**Bethanechol chloride** (Urecholine): treats urinary retention, abdominal distension
\*All are muscarinic\*
38
Indirect-Acting Cholinergic Drugs
Reversible
Myasthenia Gravis: must take meds on time
* **Ambenonium** (Mytelase)
* Endrophonium (Tensilon, Enlon)
* Neostigmine (Prostigmine)
* Pyridostigmine (Regonol, Mestinon)
Alzheimer's Disease: prolong patient's functionality
* Donepezil (Aricept)
* Galantamine (Razadyne)
* Rivastigmine (Excelon)
* Tacrine (Cognex)
39
Indirect-Acting Cholinergic Drugs
Irreversible
Used therapeutically to produce pupillary constriction
Used in the manufacture of insecticides
Used as a WOMD
40
Anticholinergics/Parasympatholytics
AKA: cholinergic blocking agents, cholinergic or muscarinic antagonists, antimuscularinic agents, antispasmodic agents
Used for **management of bradycardia**, to dry up secretion, and calm GI tract, to paralyze Parkinson's Disease
41
Anticholinergics/Parasympatholytics
Atropine
* Decreases secretions in preop patients
* Acts as antispasmodic to treat peptic ulcers (drys up secretions)
* Increaes HR in bradycardia
* Antidote for muscarinic agonist poisoning
* Side & Adverse Effects: tachycardia, dry mouth, abdominal distension, palpations, nasal congestion, photophobia, blurred vision, flushing, urinary distention
42
Anticholinergics/Parasympatholytics
Scopolamine
(Transderm Scop)
motion sickness
decrease secretions
obstetric amnesia
relief of urnary problems
IBS
43
Anticholinergics/Parasympatholytics
Dicyclomine
(Antispas, Bentyl)
hyeperactive bowel
44
Anticholinergics/Parasympatholytics
Hyoscyamine SO4
(Levsin)
peptic ulcers
IBS
45
Anticholinergics/Parasympatholytics
Glycopyrrolate
(Robinul)
decrease secretions
antidote for neuromuscular blockers
46
Anticholinergics/Parasympatholytics
Propantheline
(Pro-Banthers)
ulcers
antisecretory
antispasmodic
47
Anticholinergics/Parasympatholytics
Cyclopentolate HCl
(Cyclogyl)
for mydriasis and cycloplegia for eye exams (dilation)
48
Anticholnergics used for Tx of Parkinson's Dz
**Bentropine mesylate** (Cogentin)
**Biperiden lactate** (Akineton)
**Trihexphyenidyl HCl** (Artane)
49
Acetylcholinesterase
Breaks down Ach, increasing the amt of Ach in the body.
50
Adverse Effects of Anticholinergics
Red as a beet
Dry as a bone
Mad as a hatter
Hot as a hare
Can't see...Can't pee
Can't spit...Can't shit!
